Number cure: India needs data to fight diseases

To eradicate mosquito-borne infections, India must first get its data right. If India wants to repeat its polio success, it needs to start with getting its numbers right to make sure infections are diagnosed and treated quickly to control their spread.

The Lancet, one of the world’s top medical journals, on Tuesday reported that malaria infected 60.7 million and killed more than 116,000 people in India in 2013. This is in stark contrast with India’s official figure in 2013: 881,730 cases of infection and 440 deaths. The reason for this mismatch in data is simple. Much as we try, it’s impossible to test every person with fever for malaria. Often, the infected person recovers within a week or two, sometimes even without medical intervention. Less than 1% cases are sick enough to need treatment at a health centre. The result is that the actual cases reported are a tiny fraction of the reported numbers. This is where epidemiologists step in: They calculate the real number by modelling for missing and skewed information by factoring in ecology, temperature and population densities of people and vectors or pathogen. India has many epidemiologists, the rest of the world has more. Both claim to be using the latest evaluating tools and improved data collection techniques, but the math still doesn’t add up. And it’s not a matter of errors in decimal digits as the discrepancy in malaria numbers show.

Under-reporting cases and deaths, whether intentionally or due to incompetence, intensifies outbreaks and leads to under-treatment because of an inadequate supply of medicines and health services. And malaria is not the only mosquito-borne infection India is battling. Encephalitis outbreaks have killed 156 in Bihar, 102 in West Bengal and 43 in Assam in less than two months. Dengue outbreaks that follow the monsoons each year infect thousands and kill a few hundreds are a week or two away. India needs to get out of its almost-patented knee-jerk reaction to disease control. So far, attempts across the world have been made to eradicate eight infectious diseases, of which only two — smallpox and rinderpest (a viral cattle disease) — have succeeded. Attempts to stamp out malaria, hookworm, yaws and yellow fever were aborted after spectacular failures, while the world is still struggling against polio and guinea worm disease, a disabling parasitic disease that spreads through unsafe drinking water.

The Carter Center International Task Force for Disease Eradication has identified five more infectious diseases — measles, mumps, rubella, lymphatic filariasis and cysticercosis — as potentially eradicable with the current technology but with the world still battling polio, work on these is yet to start. If India wants to repeat its polio success, it needs to start with getting its numbers right to make sure infections are diagnosed and treated quickly to control their spread.